全球首例人感染H7N4禽流感临床救治分析  

Analysis of clinical treatment of the first case of human infection with H7N4 avian influenza virus

作　　者：童学成[1] 武幸 薛峰[2] 冯静云[2] 张燕萍 徐天敏[1] Tong Xuecheng;Wu Xing;Xue Feng;Feng Jingyun;Zhang Yanping;Xu Tianmin(Department of Infectious Diseases, Department of Intensive Care Unit, The Third People＇s Hospital of Changzhou , Jiangsu 213001 , China)

机构地区：[1]江苏省常州市第三人民医院感染科,213001 [2]江苏省常州市第三人民医院重症医学科,213001

出　　处：《中华传染病杂志》2018年第3期129-132,共4页Chinese Journal of Infectious Diseases

摘　　要：目的报告全球首例人感染甲型H7N4禽流感病例的临床救治过程，探讨人感染H7N4禽流感的临床特点及治疗方案。方法2018年1月1日江苏省常州市第三人民医院收治1例确诊人感染甲型H7N4禽流感病例，通过复习临床资料及救治经过，分析其临床特征及治疗方案，并与人感染H7N9禽流感的临床特点进行比较分析。结果患者为老年女性，存在高血压病基础，发病前有活禽暴露史。患者有发热、咳嗽、咳痰等流感样症状，发病第5天出现病情加重，表现为呼吸衰竭伴循环障碍。患者白细胞计数、淋巴细胞计数、血小板计数下降，AST、C反应蛋白轻度增高，CK、乳酸脱氢酶增高；肺部病灶短期内进展，表现为两下肺渗出、实变。依据患者流行病学病史，临床表现、实验室及影像学特点，考虑甲型禽流感可能，人院后予以积极氧疗、抗病毒、抗感染及短程激素等治疗措施，并早期及时留取咽拭子标本送检，经积极治疗患者康复出院。经中国CDC证实，该患者感染甲型H7N4禽流感，与其密切接触者均未感染。结论人感染甲型H7N4禽流感与人感染H7N9禽流感临床特征上有诸多相似之处，在临床诊治过程中可参照人感染H7N9禽流感诊疗方案早期给予神经氨酸酶抑制剂。临床上对于有禽类接触史的不明原因病毒性肺炎患者，应及时进行禽流感核酸检测，以明确病因。Objective To report the clinical management of the first case of human infection with influenza A （HTN4） in the world, and to explore the clinical characteristics and therapeutic regimen of H7N4 infection in humans. Methods A case of confirmed human infection with influenza A （H7N4） virus was hospitalized in the Third People＇s Hospital of Changzhou in Jiangsu Province on January 1st, 2018. The clinical characteristics and treatment were analyzed by reviewing the clinical data and management of the patient, and compared with the clinical characteristics of human infection with H7N9 cases. Results The patient was an elderly woman with hypertension, who had an exposure history of live poultry before onset. The patient had flu like symptoms including fever, cough and expectoration. The symptoms worsened in the fifth day and presented as respiratory failure and circulatory disturbance. The count of white blood cells, lymphocytes and platelets counts declined, while the levels of aspartate aminotransferase and c-reactive protein slightly increased. The levels of creatine kinase and lactate dehydrogenase deformity increased. The pulmonary lesions manifested as exudation and consolidation of both side in a short period of time after the onset. Treatment was initiated according to the epidemiology history, clinical manifestations, laboratory and imaging characteristics. The primary diagnosis was human infection of avian influenza virus. The patient was treated with oxygen therapy, antivirus, anti-infection and shortduration eorticosteroids treatment. Early and timely throat swab specimens were tested. The patient recovered and discharged from hospital after active treatment. It was confirmed by the Chinese Center for Disease Control and prevention that the patient was infected with avian influenza A （H7N4） virus, and no close contact was infected. Conclusions There are many similarities of clinical features between case of human infection with H7N4 and that of H7N9. The early treatment of neuraminidase inhib

关 键 词：H7N4禽流感 临床特征 流行病学 

分 类 号：R511.7[医药卫生—内科学]